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Active Surveillance- Systematic Review of Interventions
Prostate Cancer | Last Active: 19 hours ago | Replies (36)Comment receiving replies
This subject is off this threads topic (sorry Paul) so I won’t post more about it here; but I’m more than willing to discuss further, if you want to start a new thread regarding this particular subject.
These expert physicians performed a modeling study of the impact of calling GG1 “precancerous”, rather than its current “cancer” label, for reasons I already articulated.
This relabel would result in two competing outcomes.
“One argument raised by critics is this would decrease adherence with essential monitoring (active surveillance) and therefore lead to increased prostate cancer mortality. However, relabeling GG1 prostate cancer also reduces overdiagnosis and overtreatment, and given that these are the major disincentives to prostate-specific antigen (PSA) screening, it should increase use of prostate cancer screening and thereby reduce deaths from prostate cancer.”
These authors agree with you…more extensive PSA screening saves lives AND they also are allowing the critics contention that relabeling GG1 will cause more men to abandon active surveillance, thereby increasing PCa specific mortality.
In there model’s base case, which was relatively conservative, relabeling would lead to a 6-fold increase in annual prostate deaths avoided over deaths caused by lack of AS adherence, due to wider PSA screening acceptance.
They also performed numerous model scenarios, modifying inputs, all of which failed to change the final net benefit conclusion.
Overdiagnosis and overtreatment are the major disincentives to prostate-specific antigen (PSA) screening, this disincentive DECREASES if GG1 were labeled as it truly is….a non metastasizing disease.
A man’s initial fears and concerns to rush into treatment are ameliorated if he is told his CURRENT disease is precancerous and will not metastasize; BUT he will still need to diligently monitor progression (AS recommended) to ensure a more aggressive form of the disease is not found at a future date.
Replies to "@heavyphil This subject is off this threads topic (sorry Paul) so I won’t post more about..."
@handera
Here is a link to an article that discusses this relabeling of prostate cancer with a Gleason 3+3 as precancerous.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2849438
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@handera “relabeling GGI reduces overdiagnosis and overtreatment”…
…BY WHOM??
Urologists are specialists who should ALL be adhering to the current norms, which state that G3+3 and select 3+4 should be addressed by Active Surveillance. They already KNOW this.
However, if a doctor decides to go rogue and attempt to coerce patients into treatment, no change in wording is going to change that.
Case in point: I practiced dentistry for 42 years. Many, many patients have cheek biting issues - including myself. It stems from either a slight malpositioning of the teeth or an exaggerated chewing motion.
This causes a low-grade chronic injury, very similar to a callus forming on your hands; the tissue thickens from over usage. In time, some patients develop a whitish line that runs from the back of their inside cheek forward toward their mouth opening. This is called a Linea Alba.
It is totally innocuous and should be left alone – similar to a Gleason 3+3. Watch it, look for changes, but don’t do anything.
However, I had one particular oral surgeon to whom I referred patients, constantly frightening patients with the idea that this innocuous line in their mouths was going to turn into oral cancer. She would then get them in for ‘treatment’ which would consist of her scraping away the white line with the edge of a scalpel or using electrical cautery to remove it.
The patient would then return to my office and relate this harrowing tale. As diplomatically as I could, I would tell them that it was probably unnecessary and not to worry about it. Unbeknownst to me, the oral surgeon had already rescheduled the patient to return in six months to once again remove this harmless white line which by that time would have returned from constant chewing. She also sent the tissue out for a biopsy, which was another charge the patient incurred.
Finally, I spoke to the oral surgeon about this and she tried to bullshit me as well!
Needless to say, I stopped referring to her and found someone else. Yet, I am sure other unethical, rogue surgeons were doing similar things.
All I am trying to say here is that you can change the words all you want, but getting doctors to follow those words and allaying patients’ fears is quite something else. Best,
Phil